Hydrocephalus is most often treated by surgically inserting a shunt system.

The shunt re-directs the CSF out of the head through the tubing to a location elsewhere in the body where it can be absorbed.

The shunt is usually placed behind the ear and the tubing is threaded from behind the ear, under the skin,  to the area of the abdomen, heart, or lung.

Your physician will determine the drainage location based on your condition, age and other factors.

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TYPES OF SHUNTS

Many types of shunts are available.  Your child’s neurosurgeon will decide which shunt is best for your child.  Each varies slightly but generally has four parts:

• A tube called the ventricular catheter (the proximal end – nearest the point of attachment) is placed into the ventricle.  It has small holes at the end so cerebrospinal fluid (CSF) from the ventricle can flow into the tube.
• The reservoir or pump is used to test the shunt and get fluid with a needle if ever needed.  It can be felt as a small bubble, about the size of dime, under the scalp.  The reservoir and valve are close to each other.
• The valve is a small device near the reservoir or pump.  It controls the flow of CSF within a certain pressure range.  It may also prevent excessive amounts of CSF drainage (siphoning) when the child is sitting or standing (anti-siphon device).
• The distal tubing is the tube coming from the valve down to the abdomen (or heart or pleural space in some cases).  It is much longer than the ventricular catheter tube.  It is tunneled under the skin of the scalp, neck, chest, and into the peritoneal cavity.  The tubing is long, allowing it to slowly uncoil as the child grows to normal adult height.

COMPLICATIONS WITH HAVING A SHUNT

For the most part, shunts function well.  However, there are complications that can occur.  A blockage or obstruction of the shunt is the most common complication of the system. Obstruction may occur at any point along the path of the shunt.  The opening at the ventricular end may become plugged with brain, choroid plexus tissue, or blood.  The peritoneal end may also become blocked by scar tissue.  An obstructed shunt causes an increased volume of CSF in the ventricular system of the brain.  This can lead to the same symptoms as those listed below for hydrocephalus.  The shunt can be repaired (shunt revision) in surgery lasting about 1 – 2 hours.

SYMPTOMS OF SHUNT MALFUNCTION

INFANTS	TODDLERS	OLDER CHILDREN
Enlargement of the baby’s head	Head enlargement	Vomiting
Fontanell is full and tense when the infant is upright and quiet	Loss of previous abilities (sensory and motor function)	Difficulty in waking up or staying awake
Vomiting	Headache	Irritability and/or tiredness
Irritability	Seizures	Loss of coordination or balance
Sleepiness	Vomiting	Seizures
Downward deviation of the eyes		Decline in school performance
Seizures		Vision problems

A shunt infection can also cause the shunt not to work properly and cause CSF to backup, leading to enlarged ventricles. 

Signs and symptoms of shunt infection also relate to signs of shunt malfunction. 

In addition, other signs and symptoms related to shunt infection include:

• Fever.
• Redness, tenderness, skin breakdown, or fluid collection noted at the shunt on the scalp or anywhere along the shunt tract.
• Drainage at the incisional areas related to the shunt.
• Abdominal pain, tenderness, or refusing to eat or drink.

A malfunction and/or infected shunt can be a serious problem and sometimes is life threatening.  In these cases, the child is very ill and surgery is done rapidly.  In most cases the symptoms appear gradually.  They may not become serious until the ventricles are under pressure.  In some cases, the shunt can be “fixed” several days after finding the problem.

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Because serious problems may result from too frequent or improper flushing of the chamber, parents and children should NEVER try to manipulate the shunt system on their own UNLESS THEY ARE EXPLICITLY INSTRUCTED TO DO SO BY THE DOCTOR.

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